HomeMy WebLinkAboutGas Street Cut Permits 86 Rockledge Driv BOND TOWN OF SOUTH WINDSOR N o 102#
Am It Req. PUBLIC WORKS DEPARTMEM Date
TOWN HALL
It on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
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Date of Expiration • -- < Permit Expires
APPLICATION FOR PERMIT
FEE
Name and address of applicant y4r4KC-E Phone No. /Z�Z
Location of proposed work M CK E%-or.C T.W.
Describe fully nature of permit requested e.. S ewy/ �,.
Insurance on file witk Town no Date policy expires /
Name-of Insurer $("r
o Approximate time for completion 4y Desired starting date .S' o
Call before you dig ticket 11o. '
a. Show sketch of proposed work or furnish Z copies of separate drawings
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OSHA REQUIREMENTS MUST BE FOLLOWED ,
p' Applicant is responsible.for contacting the Police Depanment and CALL BEFORE YOU DIG.
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I agree to furnish to the Town of South Windsor the amount of bond or deposit requirdd and to
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair
work in connection with this permit and that I am familiar with and will abide by the rules and
regulations for permits as outlined in the Town of-South Windsor's (Pavement Cut Regulations.)
Signed
APPROVED: DATE APPROVED: DATE
Supt.of Highways Town Engineer
"FOR INSPECTOR: Date work started Date completed
Sufficient notification recei ed: ,yes no Typo of repa}r:. P.erm. _ . Temp.
------unusual- conditions encount red
Material slips attached: yes no ' Dated for Per ent repair
Signed.